China has a long history of supporting global health. Traditionally, China’s health cooperation has largely been dominated by sending medical teams overseas, building health infrastructure and donating medical commodities. However, the last ten years have seen an increase in interest from China and increasingly diverse ways of engaging in global health. This has led to a number of high-level strategies to help shape the country’s changing role and some increase in support to international or multilateral initiatives.
Currently, much of China’s increasing global health engagement comes from agencies with ‘traditional’ health mandates such as the National Health Commission and its associated agencies; health-focused research institutes and universities; and hospitals. This tends to influence the priorities for health cooperation. For example, priorities for cooperation in Africa include areas such as infectious disease control, health emergencies and workforce strengthening.
However, a series of new institutions are starting to help China play a larger global health role. They include the China International Development and Cooperation Agency (CIDCA) and inclusion of health projects in the scope of the South-South Cooperation Assistance Fund (SSCAF). Similarly, universities, para-governmental agencies and industry are experimenting with new forms of cooperation, including in science and technology, digital health, hospital-hospital pairing, and various kinds of new public health initiative amongst others. The Covid-19 pandemic has turbocharged this evolution, as China has become a major supplier of PPE and vaccines globally, and as global health has rapidly shot up the government agenda.
Governing health aid under the BRI: fragmentation and coordination
However, China’s increasing contribution to global health remains relatively separate from other elements of the country’s international engagement, notably efforts to improve infrastructure and connectivity through the Belt and Road Initiative (BRI). This is largely because China’s foreign aid, overseas infrastructure construction and direct investment are governed by different government agencies, with distinct project development, screening, approval and implementation processes that involve separate different stakeholder groups and policy communities.
Despite the establishment of CIDCA, creating synergies across government agencies is taking time – but there are opportunities to establish linkages between health and other aspects of China’s overseas cooperation.
While China is increasingly engaged in overseas infrastructure projects that support public services and goods for local communities, major gains could potentially be achieved through a more coordinated, synergistic, approach that better links health and welfare concerns with infrastructure. Such an approach could play to China’s strengths. Widespread infrastructure rollout – not just health infrastructure, but also roads, transport and providing clean water, sanitation and electricity – has played a fundamental role in improving the health and welfare of the Chinese population, especially in rural areas.
This experience could be leveraged in China’s global health cooperation. One example of how this could be applied is by harnessing China’s capacity in small-scale solar to support rural health facilities, with an eye on Africa, and some of the potential gains, especially during the ongoing Covid crisis.
Energy, poverty and health
SDG 7 calls for access to affordable, reliable, sustainable and modern energy for all, but widespread access to clean energy has important implications for multiple SDGs. There are close links between energy, poverty and health, with access to clean and sustainable energy recognised as essential to disease prevention and treatment, combating non-communicable diseases (NCDs), pneumonia prevention, vaccine coverage, digital health and emergency preparedness and response.
Right now, there is added pressure from coronavirus, given that rural healthcare facilities and extensive cold chain will be crucial in the immunisation programmes needed to achieve widespread protection against Covid-19 once countries across Africa start to receive, or manufacture, Covid vaccines in substantial quantities.
Many of these facilities are in off-grid areas and can only be powered by standby systems like traditional diesel engines or, increasingly, solar energy systems. Diesel powered generators are polluting and vulnerable to fuel supply and price instability, including during the ongoing pandemic.
This is where China has a potentially important role to play, both as the global leader in the manufacture of solar panels and due to its experience in promoting distributed solar systems in remote and rural areas. Since 2014, China has used a range of distributed solar systems to address economic and energy poverty.
Programmes referred to as ‘Solar+’ have developed a variety of models to realise social benefits, including alleviating the poverty of 2 million rural households across 35,000 villages by installing discounted solar systems for these households, who can then sell any surplus electricity back to the grid (Geall, S., & Shen, W. (2018). Subsidized Solar PV were also installed on agricultural greenhouses or even spreading over large fishponds, to provide clean energies for productive use. These innovative applications in various rural contexts can be tremendously helpful for African countries.
Realising lasting health and welfare improvements
As the Chinese government looks for new possibilities for cooperation with countries in Africa, there is value in thinking outside the box on health, and how greater linking of infrastructure, energy and health could support long-term health and welfare outcomes, as China has done domestically.
There are a number of ways this could be achieved, such as by integrating existing Chinese-supported infrastructure, including hospitals, into how China supports countries with vaccine roll out. Another is to consider how China could contribute to transport and last mile power access that will be needed to support emergency response and vaccination at scale across Africa. This could draw on technical solutions shown to be effective in China – including solar PV – in China’s evolving health cooperation.
In this way, China’s support to countries with Covid-19 vaccine supply could provide an entry point to thinking about new ways to strengthen health infrastructure in these countries over the long term. However, this will require innovation in how Chinese government thinks about health cooperation and greater linking of foreign aid, export and energy infrastructure construction systems.
At present, the export and construction sectors are dominated by large state-owned enterprises (SOEs), while development finance institutions (DFIs) focus on large scale on-grid renewable energy opportunities. A small number of initiatives have recently been launched to link health and power access in developing countries, including through the UN’s Health and Energy Platform of Action (HEPA). This is an area where China could now play a role by drawing on elements of its domestic experience through the Solar+ initiatives to help countries in the Global South.